After systemic anticoagulation, the proximal aorta was cross-clamped, and the entire prosthetic graft was excised. The vein graft was sewn end-to-end to the infrarenal aortic stump. There was an excellent size match between these two structures.
The vein graft was tunneled retroperitoneally to reach the left groin incision. After the prosthetic graft was excised from the common femoral artery, the SFPV graft was sewn end-to-side to the site of the old common femoral artery anastomosis, extending across the orifice of the profunda femoris. The second vein graft was then sewn end-to-side to the first vein graft in preparation for subcutaneous tunneling above the pubis to create a femorofemoral bypass.
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The right common femoral artery was occluded, but the superficial femoral and profunda branches were patent beyond the bifurcation. The SFPV graft was sewn end-to-end to the patent superficial femoral artery. A separate segment of SFPV graft was used to bypass directly to the profunda femoris. The picture shows the anastomotic arrangements as seen from the patient's right side.
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